CAJ | 학술논문

目的：探讨乙二醇化门冬酰胺酶（PEG - Asp）治疗成人急性淋巴细胞白血病（ ALL）的疗效和安全性。方法选取2012年3月—2014年5月于湘雅医院血液科住院治疗的成人（年龄﹥14岁）ALL 患者45例为研究对象，根据患者化疗方案，将患者分为 PEG - Asp 组（28例）和左旋门冬酰胺酶（L - Asp）组（17例）。PEG - Asp 组采用含 PEG - Asp 的 VDPAP 化疗方案，L - Asp 组以 L - Asp 替代 PEG - Asp 组成 VDLP 方案化疗，余化疗药物剂量及用药方式同 PEG - Asp 组。化疗1个疗程后评价两组近期疗效，远期疗效指标无进展生存期（PFS）、总生存期（OS）以确诊后化疗第1天为起点，随访至2014-10-10或死亡。记录化疗期间出现的毒副作用。结果 PEG - Asp 组近期疗效优于 L - ASP 组，差异有统计学意义（P ﹤0.05）。L - Asp 组 PLT 降低水平高于 PEG - Asp 组，差异有统计学意义（P ﹤0.05）。两组总有效率比较，差异无统计学意义（P ﹥0.05）。两组 PFS、OS 的生存曲线比较，差异均无统计学意义（χ2＝2.98、0.50，P ﹥0.05）。L - Asp 组 PLT 降低水平高于 PEG - Asp 组，差异有统计学意义（P ﹤0.05）。两组中性粒细胞计数降低水平比较，差异无统计学意义（P ﹥0.05）。PEG - Asp 组肝功能损害、胃肠道反应及活化部分凝血活酶时间（APTT）延长发生率低于 L - Asp 组，差异有统计学意义（P ﹤0.05）。两组肾功能损害、心脏损害、感染、出血及清蛋白下降发生率比较，差异无统计学意义（ P ﹥0.05）。结论 PEG - Asp 治疗成人 ALL 近期疗效优于 L -Asp，且肝功能损害、胃肠道反应及 APTT 延长发生率低。
목적：탐토을이순화문동선알매（PEG - Asp）치료성인급성림파세포백혈병（ ALL）적료효화안전성。방법선취2012년3월—2014년5월우상아의원혈액과주원치료적성인（년령﹥14세）ALL 환자45례위연구대상，근거환자화료방안，장환자분위 PEG - Asp 조（28례）화좌선문동선알매（L - Asp）조（17례）。PEG - Asp 조채용함 PEG - Asp 적 VDPAP 화료방안，L - Asp 조이 L - Asp 체대 PEG - Asp 조성 VDLP 방안화료，여화료약물제량급용약방식동 PEG - Asp 조。화료1개료정후평개량조근기료효，원기료효지표무진전생존기（PFS）、총생존기（OS）이학진후화료제1천위기점，수방지2014-10-10혹사망。기록화료기간출현적독부작용。결과 PEG - Asp 조근기료효우우 L - ASP 조，차이유통계학의의（P ﹤0.05）。L - Asp 조 PLT 강저수평고우 PEG - Asp 조，차이유통계학의의（P ﹤0.05）。량조총유효솔비교，차이무통계학의의（P ﹥0.05）。량조 PFS、OS 적생존곡선비교，차이균무통계학의의（χ2＝2.98、0.50，P ﹥0.05）。L - Asp 조 PLT 강저수평고우 PEG - Asp 조，차이유통계학의의（P ﹤0.05）。량조중성립세포계수강저수평비교，차이무통계학의의（P ﹥0.05）。PEG - Asp 조간공능손해、위장도반응급활화부분응혈활매시간（APTT）연장발생솔저우 L - Asp 조，차이유통계학의의（P ﹤0.05）。량조신공능손해、심장손해、감염、출혈급청단백하강발생솔비교，차이무통계학의의（ P ﹥0.05）。결론 PEG - Asp 치료성인 ALL 근기료효우우 L -Asp，차간공능손해、위장도반응급 APTT 연장발생솔저。
Objective To investigate the efficacy and safety of PEG - Asp in the treatment of adult acute lymphoblastic leukemia( ALL). Methods We enrolled 45 ALL patients( ﹥ 14 years old)who were admitted into the Department of Hematology of Xiangya Hospital from March 2012 to May 2014. According to chemotherapy regimen,the patients were divided into PEG - Asp group(n = 28)and L - Asp group(n = 17). PEG - Asp group was administrated with VDPAP chemotherapy regimen containing PEG - Asp,and L - Asp group was administrated with VDLP chemotherapy regimen containing L - Asp instead of PEG - Asp with the same dosages of other chemotherapy drugs and medication method with PEG - Asp group. After one course of chemotherapy,the short - term efficacy of the two groups was evaluated. The indexes of long - term efficacy which included progress - free survival(PFS)and overall survival(OS)were also evaluated. PFS and OS was counted from the first day after chemotherapy until October 10,2014 or death. Side effects were recorded during chemotherapy. Results PEG - Asp group was better than L - Asp group in short - term efficacy( P ﹤ 0. 05). The two groups were not significantly different in overall efficiency(P ﹥ 0. 05). The two groups were not significantly different in the survival curve of PFS and OS(χ2 = 2. 98, 0. 50;P ﹥ 0. 05). The decreased level of PLT was higher in L - Asp group than PEG - Asp group(P ﹤ 0. 05). The two groups were not significantly different in the decreased level of neutrophil count(P ﹥ 0. 05). PEG - Asp group was lower(P ﹤ 0. 05) than L - Asp group in the incidence rates of liver function damage,gastrointestinal reaction and prolonged APTT. The two groups were not significantly different( P ﹥ 0. 05 ) in the incidence rates of renal function damage,cardiac damage,infection, haemorrhage and decrease of albumin level. Conclusion PEG - Asp is superior to L - Asp in the short - term efficacy of adult ALL patients and has lower incidence rates of renal function damage,gastrointestinal reaction and prolonged APTT.